Hospital Transition Management. Barbara Wood, BSN, MBA

Transcription

1 Hospital Transition Management Barbara Wood, BSN, MBA Director, Embedded Care Management Programs

2 OBJECTIVES Improve health care quality for our patients by streamlining care transitions Reduce avoidable costs during care transitions Reduce preventable hospital admissions, readmissions, and ER visits

3 GOALS Improve the patient experience Ensure the best possible outcomes

4 STRATEGIES 1. Hospitalists provide medical-necessity assessments for patients in the emergency department 2. Personalized transition management for admitted patients 3. Coordinated transitions with skilled nursing facilities and home health agencies 4. Engaging patients with their end-of-life choices

5 THE METHOD The Four Pillars: Teach Teach a Provide Have a Medication patient about knowledge patient set Self- their condition of warning up follow-up management and use of symptoms care with a personal and how to their doctor health record respond

6 PATIENT EXPERIENCE

7 GOALS AND MEASUREMENT $51 million total savings for 2010 OBJECTIVES Reduce inpatient costs and readmit rates by providing consistent and reliable post-acute care transitions Optimize post-acute care processes Reduce unnecessary Emergency Department (ED) utilization and costs METRICS Readmit rate IP admit rates Hospital length of stay (LOS) SNF admits/1,000 SNF LOS ED visits/1,000

8 Patient Satisfaction: SEPT st percentile DEC th percentile

9 $51m HOSPITAL COST SAVINGS

10 RESULTS

11 Medicare patient readmission: NATIONALLY: 19.6% 6 WASHINGTON: 16.4% GROUP HEALTH: 15%

12 OVERALL IMPROVEMENT Medicare inpatient admits by 6.3% Medicare inpatient days by 3.3% Non-Medicare inpatient admits by 7% Non-Medicare inpatient days by 10% SNF Medicare admits SNF Medicare inpatient days by 5% ER visits it by 5%

13 Medication Reconciliation By Ambulatory Clinical i l Pharmacists Post-Hospital Discharge Diane Schultz, RPh Medication Safety Manager

14 Background: Current Literature Medication Reconciliation Post-Discharge Common Primary Outcomes Medication Discrepancies Adverse Drug Events Readmit Rates

15 Background: Common Outcomes Post hospital discrepancies i Reducing adverse drug 14% had 1 or more 1 events 71% an unintentional discrepancy 2 Discrepancy-associated ADEs lower in intervention group 3

16 Med reconciliation Care team with Collaborative med rec 2-4 days post discharge 4 pharmacist med rec 5 with physician 6 Readmit rates 30 days readmit rates Time to readmit 30 days readmit rates Visits to ED

17 Study Objective A retrospective, quality improvement study To assess the impact of ambulatory clinical pharmacist medication reconciliation for patients post discharge on the following outcome measures: Primary Outcomes Readmission Rates Financial Savings Secondary Outcome Medication Discrepancies

18 Methods: Participants Patient in Care Management Discharged: hrs: Care Manager calls Intervention 3-7 days: Clinical Pharmacist calls Medication Reconciliation Control No Clinical Pharmacist call No Medication Reconciliation

19 Methods: Intervention PATIENT PHARMACIST Pharmacist Calls Patient 1. Reviews current medications 2. Discusses findings from PCP DOCUMENTATION Data Collection Tool Group Health records comparing hospital list and Group Health records 3. Ensures patient understanding

20 Methods: Data Collection What does the Data Collection Tool capture? 1. *Medication Discrepancies 2. Patient number and Primary Care clinic 3. Discharge hospital and date 4. Discharge summary availability 5. Clinical Pharmacist time spent *Medication discrepancies (quantity) Medication omissions, therapeutic duplicates, dose changes, discontinued medications and drug-drug interactions *Other primary data resources: daily discharge census reports, readmission reports*

21 Results Readmission Rates Financial Savings Medication Discrepancies

22 Results: Participants Baseline Demographics Intervention Control (N = 281) (N = 275) Average Age % Female % >65 years on High Risk Meds in Elderly 9% 13% *Differences not statistically significant *Discharge Diagnosis Intervention Control Cases Cases CHF 1 5 Pneumonia 1 4 Cancer 2 4 Intestinal Obstruction 3 4 Chest Pain 3 4 GI Hemorrhage 3 3 Alcohol Dependence 2 2 Shortness of Breath 2 1

23 Results: Primary Outcomes Decreased Readmission Rates 30 Control (N = 275) Intervention (N = 281) % Hospital Readmits Day 30 Day 60 Day p = P 0.05 is statistically significant

24 Results: Decreased Readmit Rates 14 day readmissions Intervention Control # of readmits N % of readmits 4 9 Number Needed to Treat (NNT): 5 per 100 patients For every 20 patients that receive Clinical Pharmacist medication reconciliation, 1 hospital readmission is prevented.

25 Results: Primary Outcomes Financial Savings Prevent 5 readmissions per 100 patients Savings: Cost of Readmission Cost: Clinical Pharmacist Time $8,000 per readmit 36 min per med rec Total Savings $37, 000 per 100 patients *Based on 14 day Readmit Rates

26 Results: Secondary Outcome Medication Discrepancies Medication Discrepancies i % patients t (from Data Collection Tool) with 1 or more Discontinued Medications 48% Dose Changes 45% Omissions 44% Therapeutic Duplicates 19% Drug-drug Interactions - 8L Level l1 clearly l contraindicated t d - 9 Level 2 causing severe adverse reactions - 9 Level 3 causing moderate adverse reactions 8% 80% of patients had 1 or more medication discrepancies.

27 Study Limitations Manual Documentation Study not powered to detect t difference in 30 and 60 day readmission rates Potential differences in baseline characteristics: unable to control for due to design of study

28 Conclusion Medication Discrepancies Resolved Decreased Readmit Rates Financial Savings

29 References 1. Coleman EA, et al. Posthospital Medication Discrepancies: Prevalence and Contributing Factors. Arch Internal Med. 2005; 165: Wong JD, et al. Medication reconciliation at hospital discharge: evaluating discrepancies. Ann Pharmacother Oct; 42(10): Boockvar KS, et al. Medication reconciliation for reducing drugdiscrepancy adverse events. J Am Geriatr Soc Sept; 4(3): Jack BW, et al. A reengineered hospital discharge program to decrease re-hospitalization: a randomized trial. Ann Intern Med Feb; 150(3): Koehler BE, et al. Reduction of 30-day post-discharge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle. J Hosp Med Apr; 4(4): Param D, et al. A Quality Improvement Intervention to Facilitate the Transition of Older Adults from Three Hospitals Back to Their Homes. J Am Geriatr Soc Aug; 57:

30 Questions?